Randomized Trial of an Internet-based Program for Patients Living With Multiple Chronic Diseases

The aim of the Internet-based Chronic Disease Management (iCDM) study is to develop and evaluate a multi-chronic disease management program (MyHealthConnect) delivered through the Internet, with telephone supports.

The iCDM targets patients with multiple high-impact chronic diseases living in areas outside of large urban centres. This single-blinded randomized controlled trial will test the effect of MyHealthConnect on healthcare utilization and patient quality of life outcomes, long-term compliance to the program, and levels of patient and provider satisfaction.

Background

Chronic diseases – diseases such as ischemic heart disease, heart failure, diabetes, chronic kidney disease and chronic lung diseases that are managed but cannot be cured – are becoming an increasing burden to the Canadian healthcare system and to the patients who have them. Patients with these types of chronic conditions account for a substantial proportion of hospitalizations and premature mortality. Many have more than one of these chronic diseases (e.g., diabetes and kidney disease), which pose unique challenges because these individuals are more likely to develop complications, in addition to receiving limited coordinated care across disease specialties (ie: redundant lab tests, contradictory care plans, etc.).

For patients who live in remote, rural and small urban areas, they are especially vulnerable to the consequences of chronic diseases due to reduced access to healthcare. These patients create additional complexities for healthcare as they present with greater risk factors, hospitalization rates and mortality rates from chronic diseases than urban patients.

For effective chronic disease management to happen, the focus needs to shift to a multi-disciplinary team-based approach which includes proactive and coordinated care, and includes the patient as an active team member in order to enhance self-management for day-to-day problems. Online programs have been found effective in this patient self-management of chronic diseases, and have additionally been identified as a promising tool in rural areas where access to medical care is especially challenging.

Objectives

The purpose of this study is to test the efficacy of an internet-based chronic disease management program with regard to healthcare utilization and self-management outcomes, patient and provider satisfaction, and long-term compliance. If effective, patients with multiple chronic diseases utilizing the MyHealthConnect program will have lower hospital admissions over a two-year period compared to patients utilizing usual care only.

Methodology

Patients are recruited through more than 130 primary care physicians practising outside of major urban areas in Fraser Health, Interior Health, Northern Health, Vancouver Coastal Health and Vancouver Island Health. The total sample consists of 318 participants with daily internet access who have two or more of the targeted chronic diseases (ischemic heart disease, heart failure, diabetes, chronic kidney disease and chronic obstructive pulmonary disease (COPD)).

Following the baseline assessment, patients are randomized to a usual care or intervention group. The usual care group is given educational materials and is contacted again only at follow-up intervals. The intervention group has access to the online MyHealthConnect program throughout this 24-month period.

MyHealthConnect supports patient self-management through collaborative planning and goal setting, education and skill development, support for behaviour change, and regular patient monitoring with follow-up. In addition, it works to support the relationship between the patient and their primary care provider.

Upon initiation, action plans - which coordinate patient care across their disease conditions - are developed between the patient, the MyHealthConnect nurse and the primary care provider. Patients then log into MyHealthConnect at regular intervals to answer questions and enter data related to their diseases. If their answers indicate their symptoms are increasing, an alert is sent to the nurse who follows up with the patient by telephone to discuss if any further action is needed (ie: telephone counselling, review with their local physician, etc.). If their symptoms fall within desirable parameters, the patient continues entering their data. Patients also have access to a dietitian, exercise specialist and to psychosocial support through MyHealthConnect.

Progress To Date

The study is currently conducting one- and two-year follow-ups with participants. It is also completing physician and patient exit interviews with those who have finished the study.

Anticipated Outcomes

It is anticipated that MyHealthConnect will provide support and improved access to care to those patients in small urban and rural areas. By supporting patient management and coordination of care across different diseases, MyHealthConnect will result in improved patient health and quality of life, improved provider satisfaction and reduced healthcare utilization.